PA_Pro_May_2015

T H E L E A D I N G N E W S R E S O U R C E F O R P H YS I C I A N A S S I S TA N T S
M AY 2 0 1 5
IMAGINE
WHAT’S NEXT
FOR AAPA CONFERENCE 2015
Experts onWhat the Future
Holds for PAs

CONFERENCE
AAPA
MAY 14 – 18, 2016
San Antonio, TX
save the datE!
power uP
Learn MOre
aapaconference.org

ContentsM AY 2 0 1 5 • V O L . 7 , N O . 5
Departments
President’s Letter
A milestone year
Laws + Legislation
Antitrust immunity not a given for state
licensing boards
STAT
Passage of Medicare reform law is a victory
for PAs; A PA first at the White House; PA
scope of practice article; U.S. News & World
Report on why America needs PAs
Professional Practice
Taking the anxiety out of resume
and cover letter writing
First Rounds
PA students on leadership
On Point
Each one, teach one
Eating Well
Simple summery salads
Reflections
New PA grad on bloodless medicine
and surgery rotation
4
6
10 44
34
38
46
49
AAPA / Navigating Healthcare
Look for AAPA’s Navigating Healthcare icon to read
stories on the Affordable Care Act and the broader
changes impacting PAs in this rapidly changing
healthcare environment.
Visit our AAPA /Navigating Healthcare page
to see what else we are doing
for you.
C O V E R S T O R Y
Imagine What’s Next
for the PA Profession
Experts on What the Future Holds
17 24
30
25
7
F E AT U R E S T O R I E S
PA Executive Profile:
PA Laurie Benton
Leading by Example
2015 AAPA Award
Winners Announced
Honoring PA Achievement
Features
PA PROFESSIONAL | MAY 2015 | AAPA.ORG | 1

CAREER FAIR
Connect
Meet employers actively hiring PAs
Explore
Learn about new job opportunities in a relaxed setting
Practice
Sharpen your “elevator speech” and interview skills
May 25, 1:00-3:30 p.m.
San Francisco Moscone Center
Gateway Ballroom 102
Reading this on site and you’re not registered? No problem!
Stop by and we’ll register you here. You can still attend the event!
Click Here To Register Today!Visit Us At The Hub!
See You Here!
Don’t miss our presentations beginning Saturday, May 23
through Tuesday, May 26!
All times 10:15 a.m.
• Saturday, May 23
Topic: Resume – Do’s and Don’ts
• Sunday, May 24
Topic: How to get the most out of your job search
• Monday, May 25
Topic: Preparing for the Career Fair
• Tuesday, May 26
Topic: Contracts - Do’s and Don’ts
PLUS: AAPA’s PA Career Coach will be on site to complete
Resume Reviews, help with contract negotiations and assist
with other questions you have about your PA career. Stop by
the booth to reserve your time slot!

©Copyright2015bytheAmericanAcademyofPhysicianAssistants.PAProfessionalispublishedmonthlyandisaregistered
trademark of AAPA, 2318 Mill Road, Suite 1300, Alexandria, VA 22314-6868.
MAGAZINE STAFF
PUBLISHER
Amy Noecker
anoecker@aapa.org
EDITOR-IN-CHIEF
Janette Rodrigues
jrodrigues@aapa.org
SENIOR WRITER
Ashley Kent
akent@aapa.org
WRITER/COPY EDITOR
Cherise Carrera
ccarrera@aapa.org
GRAPHIC DESIGNER
Joan Dall’Acqua
jd@acquagraphics.com
CLASSIFIED AND DISPLAY ADVERTISING SALES
Tony Manigross
571-319-4508
tmanigross@aapa.org
2318 Mill Road, Suite 1300
Alexandria, VA 22314-6868
PH: 703-836-2272 | FX: 703-684-1924
EM: aapa@aapa.org | WB: aapa.org
AAPA BOARD OF DIRECTORS
PRESIDENT
John McGinnity, MS, PA-C, DFAAPA
CHAIR OF THE BOARD / IMMEDIATE PAST-PRESIDENT
Lawrence Herman, PA-C, MPA, DFAAPA
PRESIDENT-ELECT
Jeffrey Katz, PA-C, DFAAPA
VICE PRESIDENT/SPEAKER OF THE HOUSE OF DELEGATES
L. Gail Curtis, MPAS, PA-C, DFAAPA
SECRETARY-TREASURER
Josanne Pagel, MPAS, PA-C, Karuna RMT®, DFAAPA
FIRST VICE SPEAKER
David I. Jackson, DHSc, PA-C, DFAAPA
SECOND VICE SPEAKER
William T. Reynolds Jr., MPAS, PA-C
DIRECTOR-AT-LARGE
Michael Clyde Doll, MPAS, PA-C, DFAAPA
DIRECTOR-AT-LARGE
Alan N. Bybee, MPA, PA-C, DFAAPA
DIRECTOR-AT-LARGE
Diane Michelle Bruessow, PA-C, DFAAPA
DIRECTOR-AT-LARGE
Daniel L. O’Donoghue, PA-C, PhD
DIRECTOR-AT-LARGE
Lauren G. Dobbs, MMS, PA-C
STUDENT REPRESENTATIVE
Melissa Ricker, PA-C
CHIEF EXECUTIVE OFFICER
Jennifer L. Dorn, MPA
V O L 7 | N O 5 | M AY 2 0 1 5
AAPA.ORG

PRESIDENT’SLETTER
A Milestone Year!
W
hen the U.S. Senate passed the Medicare and
CHIP Reauthorization Act (HR 2) on April 14,
sending the historic bipartisan bill to President
Obama to sign, it represented a sizable victory for PAs and
our patients. Indeed, this legislation represents the most
significant Medicare reform in decades.
Medicare’s troubled physician payment formula is history,
and PAs now have payment certainty. The vital role we have
always played in healthcare delivery is increasingly being
recognized—and we’re accomplishing this together.
Together, through the dedicated efforts of PAs, constitu-
ent organizations and AAPA, we have eliminated an unprec-
edented number of barriers to PA practice. In 2014, our col-
lective work resulted in 184 PA-positive improvements to
laws and regulations in 49 states and the District of Colum-
bia—no small feat. Our collective momentum that began in
2013 gained speed in 2014, and is continuing into 2015.
Together, we have seen inspiring results from a recent
Harris Poll survey, commissioned by AAPA, showing the
nation that PAs are trusted healthcare providers who
improve patient access to care. We’ve seen Forbes, U.S. News
& World Report, and The New York Times tout our profession
as one of the best healthcare jobs, and praise PAs as one of
the single most, sought-after healthcare providers in the
country. We’ve seen demand for PAs rise by more than 300
percent in the last three years. And, the National Governors
Association encouraged all states to allow PAs to practice to
the fullest extent of their experience and education. This
growing recognition matters.
Together we aggressively moved away from the term
“assistant,”using “PA” instead. We made sure that our audi-
ences—the media, legislators, employers, physicians,
patients and the public—know exactly what a PA is, what
PAs do, and why that’s making the defining difference in
healthcare today.
We will continue to rise to the challenge of practicing
medicine in this rapidly changing healthcare landscape.
These are disruptive yet exciting times for PAs. We continue
to thrive amidst this upheaval because we are stronger
together.
Whether I see you in a few weeks at AAPA Conference 2015
in San Francisco, or we’ve only connected through these
letters in PA Professional, I’d like to thank you for the hard
work you do every day in your practice, clinical rotation or
classroom. It has been my honor and privilege to serve as
your president, and I’ve never been prouder to be a PA.
John McGinnity, MS, PA-C, DFAAPA
AAPA President

The threat of a malpractice claim is very real,
which is why AAPA endorses PA Protect®
for its members’ professional liability protection. Unless
you have your own coverage - in your name alone - you may not have all of the legal
protections you’ll need in the event of a claim against you. The NEW PA Protect®
underwritten
by MedPro, which enjoys an A++ A.M. Best Financial Strength Rating*, offers enhanced
coverage features and the benefits you need most - at prices you can afford.
Whether you are a full-time,
part-time or moonlighting PA
in a family practice, emergency
room or virtually any setting in
between, PA Protect®
offers
insurance security, designed
for your unique professional
needs, PLUS an AAPA risk man-
agement credit of up to 10%.
Apply Today!
www.PA-Protect.com
The Best Malpractice Protection Just Got Better.
The NEW Enhanced PAProtect®
99 Hudson Street, 12th Floor
New York, NY 10013-2815
Tel: 1-800-221-4904
Fax: 646-390-5163
info@cmfgroup.com
www.PA-Protect.com
Most credit cards accepted.
NEW PA Protect®
Coverage Highlights
Professional Liability Included
Workplace Liability Included
License Defense $25,000 per claim
HIPAA Defense $25,000 per claim
Deposition Defense $10,000 per claim
First Aid $15,000 per claim
Loss Of Earnings $ 2,500 per day
Good Samaritan Included
Biomedical Defense $10,000 per claim
Workplace Violence/Assault $25,000 aggregate
Medical Payments $25,000 per claim
* Medical Protective internal data 2009-2013. Product availability varies based upon busi-
ness and regulatory approval and differs between companies. All products administered
and underwritten by Medical Protective or its affiliates. Visit medpro.com/affiliates for
more information. ©2014 The Medical Protective Company.® All Rights Reserved. A.M.
Best Rating as of 5/9/14.

LAWS+LEGISLATION
Antitrust Immunity Not a Given
for State Licensing Boards
Supreme Court’s Decision May Have Implications for PAs
B Y S T E P H A N I E R A D I X , J D
T
he U.S. Supreme Court issued a 6-3 ruling on Feb.
25, 2015, in N.C. State Board of Dental Examiners v.
Federal Trade Commission (FTC) that immunity
from Sherman Act antitrust laws does not automatically
apply to state boards consisting of a controlling number
of active market participants who are not actively super-
vised by the state.
Established by state law to regulate the practice of den-
tistry, the North Carolina Board of Dental Examiners
(board) is composed of six practicing dentists—who are
all active market participants—one consumer and one
dental hygienist. In the 1990s, dentists in the state, includ-
ing members of the board, began offering teeth whiten-
ing services, which were very lucrative.
A decade later, non-dentists also began to offer the ser-
vices at much lower prices, which resulted in complaints
from dentists. Although the state’s Dental Practice Act
does not specify that teeth whitening is the practice of
dentistry, such an absence did not stop the board from
issuing nearly 50 cease-and-desist letters to non-dentist
teeth-whitening service providers. These letters cautioned
that the unlicensed practice of dentistry was a crime and
insinuated that by providing teeth whitening services the
non-dentists were committing a crime and should imme-
diately stop offering the service.
In 2010, the FTC brought an administrative complaint
alleging that the board’s endeavors to preclude non-den-
tists from the teeth-whitening services market constituted
unfair and anticompetitive acts in violation of the Sher-
man Act. An administrative law judge (ALJ) determined
that the board’s actions were a violation of the Sherman
Act and ordered the board to halt further communications
to non-dentists regarding the discontinuation of teeth-
whitening services.
The ALJ also required the board to notify recipients of
the letters of their right to seek declaratory rulings in state
court. The board appealed these findings to the 4th U.S.
Circuit Court of Appeal,s which affirmed the FTC’s ruling.
STEPHANIE RADIX, JD, is an
AAPA director of constituent
organization outreach and
advocacy. Contact her via email
or 571-319-4355.

LAWS+LEGISLATION | continued
A Life-Changing Career
What if your career could change your life?
Mayo Clinic and Mayo Clinic Health System use the power of collaboration to achieve the highest standards for
medical care and health improvement. We are seeking Physician Assistants to join our practice. We invite you to
explore our opportunities throughout our sites in Arizona, Florida, Georgia, Iowa, Minnesota, and Wisconsin.
Mayo Clinic has been recognized as the best hospital in the nation for 2014-2015 by U.S. News and World Report
“America’s Best Hospitals.” Our multi-disciplinary group practice focuses on providing high quality, compassionate
medical care. We are the largest integrated, not-for-profit medical group practice in the world with over 60,000
employees working in a unique environment that brings together the best in patient care, groundbreaking research
and innovative medical education. We offer a highly competitive compensation package, which includes exceptional
benefits, and has been recognized by FORTUNE magazine as one of the top 100 “Best Companies to Work For.”
To learn more or to apply, visit: http://mayocl.in/1xrM1ar
Connect with us!
Be the first to hear about new jobs and career-related news from Mayo Clinic.
©2015 Mayo Foundation for Medical Education and Research. Post offer/pre-employment drug screening is required. Mayo Clinic is an equal opportunity educator and employer (including veterans and persons with disabilities).
1 North Carolina State Board of Dental Examiners vs. Federal Trade Commission,
No. 13-354, slip op. at 6 (U.S. Feb. 25, 2015).
2 Id. At 14.
This led the board to take its appeal to the highest court possible, the U.S.
Supreme Court.
In its ruling, the Supreme Court sided with the FTC and rejected the
board’s defense of state-action immunity, holding that“[a] non-sovereign
actor controlled by active market participants—such as the board—enjoys
immunity only if it satisfies two requirements: first, that the challenged
restraint … be one clearly articulated and affirmatively expressed as state
policy, and second, that the policy … be actively supervised by the State.”1
Since the Dental Practice Act is silent on whether teeth whitening consti-
tutes the unauthorized practice of dentistry and because the state did not
supervise the board’s actions in sending its cease-and-desist letters, state-
action immunity was inapplicable. A board’s formal designation as a“state
agency”by states does not itself create automatic immunity. In this case,
market participants in the same occupation that the board regulates also
control the board.“When a State empowers a group of active market par-
ticipants to decide who can participate in its market and on what terms
the need for supervision is manifest.”2
Takeaways from the decision include:
■ State boards run by active market participants will be encouraged to
more closely evaluate any potentially anticompetitive activities and
ensure adequate supervision by the state before taking action;
■ It remains to be seen whether the requirement of active state supervi-
sion must be met by boards having no involvement from market
participants;
The full impact of the Supreme Court’s decision is not yet known. But
what is known is that the decision will have nationwide impact, and it will
influence the way state regulatory boards operate. AAPA is paying close
attention to all implications and developments resulting from the decision
and will work with its constituent organizations to incorporate new infor-
mation into advocacy plans.

Connect with top employers from around the country looking to hire
physician assistants from the comfort of your home or office.
Network, make contacts and find the job that’s right for you!
AAPA Virtual Career Fair
Wednesday October 7, 2015
12:00pm - 3:00pm EDT
Register Here
MeetYour Self-Assessment
CME Credit Requirements
Learn more at http://knowledgeplus.nejm.org/PAspecial
With NEJM Knowledge+ Family Medicine Board Review, you can earn up to 20 of
your required Self-Assessment CME credits, and earn additional AMA PRA credits.
This comprehensive primary care question bank is relevant to your practice and
covers the broad body of medical knowledge you learned in training.
Enjoy and benefit from a personalized learning
experience—the adaptive learning technology
at the core of NEJM Knowledge+ enables you
to focus your time studying exactly where
you need to review the most and to see your
progress in real time.
• The ability to earn up to 20 AAPA
Category 1 Self-Assessment CME
credits and over 200 AMA PRA
Category 1 Credits™
• An extensive question bank—thoroughly
reviewed and approved by experienced
PAs and PA educators— as ideal for
PANCE and PANRE review materials
• Two timed practice exams
• Robust progress and proficiency
reporting to help you identify strengths
and weaknesses
• Convenient, mobile access
20%
D
ISCO
U
N
T
Special Introductory
O
ffer

© January 2015, Depomed, Inc. All rights reserved. APL-MULT-0029
We are proud to support the
American Academy of Physician Assistants Annual Conference.
Please visit us at the 2015 Annual Meeting
at our Exhibit booth and our Product Theater.
As a leader in Pain Management and Neurology, we offer the following products:
Please see Important Safety Information on the following page
and at our Depomed Exhibit Booth.
IMPORTANT SAFETY INFORMATION
ZIPSOR®
(diclofenac potassium) Liquid Filled Capsules
Lazanda®
(Fentanyl) Nasal Spray
WARNING: RISK OF SERIOUS CARDIOVASCULAR AND GASTROINTESTINAL EVENTS
Cardiovascular Risk
• Nonsteroidal anti-inammatory drugs (NSAIDs) may increase the risk of serious cardiovascular (CV) thrombotic
events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use.
Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk [see
Warnings and Precautions (5.1)].
• ZIPSOR is contraindicated for the treatment of perioperative pain in the setting of coronary artery bypass graft
(CABG) surgery [see Contraindications (4)].
Gastrointestinal Risk
• NSAIDs increase the risk of serious gastrointestinal (GI) adverse reactions including, bleeding, ulceration, and
perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use
and without warning symptoms. Elderly patients are at greater risk for serious gastrointestinal events [see
Warnings and Precautions (5.2)].
WARNING: RISK OF RESPIRATORY DEPRESSION,
MEDICATION ERRORS, ABUSE POTENTIAL
See full Prescribing Information for complete
boxed warning.
• Due to the risk of fatal respiratory depression,
Lazanda is contraindicated in opioid non-
tolerant patients and in the management of
acute or postoperative pain, including headache/
migraines.
• Keep out of reach of children.
• Use with CYP3A4 inhibitors may cause fatal
respiratory depression.
• When prescribing, do not convert patients
on a mcg per mcg basis from any other oral
transmucosal fentanyl product to Lazanda.
• When dispensing, do not substitute with any
other fentanyl products.
• Contains fentanyl, a Schedule II controlled
substance with abuse liability similar to other
opioid analgesics.
• Lazanda is available only through a restricted
program called the TIRF REMS Access program.
Outpatients, healthcare professionals who
prescribe to outpatients, pharmacies, and
distributors are required to enroll in the program.
CAMBIA®
(Diclofenac Potassium for Oral Solution)
WARNING: RISK OF SERIOUS CARDIOVASCULAR
AND GASTROINTESTINAL EVENTS
Cardiovascular Risk
• Non-steroidal anti-inflammatory drugs (NSAIDs)
may increase the risk of serious cardiovascular
(CV) thrombotic events, myocardial infarction,
and stroke, which can be fatal. This risk may
increase with duration of use. Patients with
cardiovascular disease or risk factors for
cardiovascular disease may be at greater risk
[see Warnings and Precautions (5.1)].
• CAMBIA is contraindicated for the treatment
of peri-operative pain in the setting of
coronary artery bypass graft (CABG) surgery
[see Contraindications (4) and Warnings and
Precautions (5.1)].
Gastrointestinal Risk
• NSAIDs increase the risk of serious
gastrointestinal (GI) adverse events including
bleeding, ulceration, and perforation of the
stomach or intestines, which can be fatal. These
events can occur at any time during use and
without warning symptoms. Elderly patients are
at greater risk for serious gastrointestinal events
[see Warnings and Precautions (5.2)].
© January 2015, Depomed, Inc. All rights reserved. APL-MULT-0029
For additional Safety Information about Lazanda,
please visit www.lazanda.com or visit our booth #321
For additional Safety Information about Zipsor, please visit www.zipsor.com or visit our booth #321
For additional Safety Information about CAMBIA, please
visit www.CambiaRx.com or visit our booth #321

STAT | Industry News
PASSAGE OF MEDICARE REFORM LAW
IS A VICTORY FOR PAs
PAs won a significant victory in the bipartisan Medicare
reauthorization legislation that was signed into law by
President Obama on April 16, 2015. The statute includes
an increase in Medicare payment rates for PAs and other
providers for each of the next five years, reduces a num-
ber of barriers to effective PA practice under the Medicare
program, and elevates the profile of PAs as vital health-
care providers to America’s seniors. Importantly, changes
in the Medicare program are a bellwether for changes in
private insurance practices, as well.
AAPA and its members played an active role in support-
ing the legislation, which represents the most significant
Medicare reform in decades.“Through AAPA-organized
meetings with lawmakers and key committee staff in
Congress, as well as a significant grassroots effort, hundreds
of PAs from across the nation urged Congress to make these
long overdue changes.Their advocacy really helped make a
difference for PAs,”said AAPA CEO Jenna Dorn.
AAPA President John McGinnity, MS, PA-C, DFAAPA,
applauded several specific provisions of the law.“This
legislation matters—a lot. It means we can expect to
see greater stability in Medicare provider payment rates,
which affects not only practitioners, but patients, as well”
he said.“Plus, we’ve too often seen legislative and regu-
latory roadblocks that prevent PAs from delivering the
medical care that they have been trained and licensed to
provide. In this case, PAs worked with lawmakers to seize
this opportunity to eliminate some important barriers to
better patient care.”
A PA FIRST AT THE WHITE HOUSE
Maj. Saibatu Mansaray-Knight, U.S. Army, SP, PA-C,
recently became the first medical officer to be
selected as the Army military aide to the vice presi-
dent of the United States.
“This prestigious position is usually held by a
line officer, such as an infantry officer or pilot,”said
James J. Jones, PhD, PA-C, deputy director and
chief of protective medicine, White House Medical
Unit (WHMU).“It’s not a medical role at all—which
makes her appointment unique.”
The military aide ensures that the vice presi-
dent is ready at a moment’s notice to assume the
presidency if the president is unable to perform
his duties. This can be because of the president’s
death, resignation or temporary incapacitation, or
if the vice president and a majority of the cabinet
judge that the president is no longer able to dis-
charge the duties of the presidency.
An Iraq veteran
and graduate of the
Interservice PA Program,
Mansaray-Knight is no
stranger to firsts. She is
the first female Army PA
assigned to the White
House Medical Unit
(WHMU) selected below
the zone for Major, as
well as the first female
PA to serve as WHMU
director of operations.
Part of the White House Military Office, the
WHMU is responsible for the medical needs of the
president, vice president and their families, as well
as White House staff and visitors. There are cur-
rently 15 PAs serving in the WHMU, more than at
any other time in the PA profession’s history.
PA RECEIVES NATIONAL RURAL
HEALTH AWARD
Steven R. Shelton, MBA, PA-C, received the Louis Gorin
Award for Outstanding Achievement in Rural Health
Care from the National Rural Health Association in April
for his work in education and improving healthcare
access in rural America. The NRHA’s highest honor, the
Gorin Award is presented to an outstanding individual
committed to improving the health of Americans.
Currently, he is the assistant vice president for commu-
nity outreach at the University of Texas Medical Branch
(UTMB) in Galveston, Texas, and the director of the Texas
East Area Health Education Center program. A force in
rural health for 40 years, he is nationally recognized for
his work in primary care workforce development, health
literacy, PA education and practice, and addressing
health disparities.
Shelton has also helped mobilize community response
to catastrophic events, including the Columbia space
shuttle accident, the West Fertilizer plant explosion and
hurricanes Katrina, Rita and Ike. An AAPA member, he
is a 1975 graduate of the University of Texas Medical
Branch (UTMB) PA program in Galveston, Texas.
PA Steven R. Shelton
PHOTOCOURTESYOFWHMU
Maj. Saibatu
Mansaray-Knight PA PROFESSIONAL | MAY 2015 | AAPA.ORG | 10
PHOTOCOURTESYOFUTMB

STAT | continued
PA SCOPE OF PRACTICE ARTICLE
In March, the Annals of Health Law: The Health
Policy and Law Review of Loyola University Chicago
School of Law (vol. 23, no. 3), published“Access and
Innovation in a Time of Rapid Change: Physician
Assistant Scope of Practice”by AAPA staff and
noted PA researchers Jim Cawley and Rod Hooker.
The article traces the evolution of PA practice from
a legal and regulatory standpoint and explores
potential new roles for PAs in the changing health
care environment. [link coming]
U.S. NEWS & WORLD REPORT ON WHY
AMERICA NEEDS PAs
U.S. News & World Report explains the high
demand for PAs in“Physician Assistants Graduate to
a Healthy Job Market,”the most recent in a series of
articles the venerable news magazine has done on
the profession.
PA EARNS 2015
HEALTH MONITOR
LIFECHANGER
AWARD
Jerin D. Bryant, PA-C, of
Kingsville, Texas, was
recently named the 2015
Health Monitor LifeChanger
Award winner. A graduate of
the University of Texas-Pan
American PA program, she
was nominated for the award by a patient, who
credits the PA with saving her husband’s life. The
award recognizes the work of a PA who has made
a difference in a patient’s life.
Along with being featured in an online and print
campaign by Health Monitor, Bryant won a free
trip to AAPA Conference 2015 in San Francisco,
where she will be honored before her peers at the
PA Foundation’s A PAramount Evening from 6:30–
10:00 p.m., Tuesday, May 26.
PA PART OF PIH EBOLA RESPONSE TEAM
Allendre Lindor, MS, MPH, PA-C, a 2014 graduate of the Rutgers PA program,
recently returned from six weeks in Sierra Leone, where he was part of a Partners
in Health (PIH) Ebola response team. As a member of the team, he worked on a
project to improve the country’s primary care infrastructure to help combat the
current Ebola outbreak, and, hopefully, prevent future ones.
“I couldn’t continue to sit idly by watching the news stories knowing I had a
skillset that could be beneficial,”Lindor said recently.“This experience allowed me
to see both sides of the devastating impact the Ebola outbreak has had on Sierra
Leone’s already fragile healthcare system, still reeling from years of Civil war.”
Lindor, an Iraq veteran, applied for the PIH position through the USAID.gov Ebola response site.
He worked in the Ebola Treatment Unit and the Port Loko Government Hospital. PIH is a healthcare
nonprofit founded by Paul Farmer, MD, and others to improve access to healthcare in the developing
world. Sierra Leone’s healthcare workers were hit particularly hard by the Ebola outbreak. Lindor said
primary care in the country was decimated after any available healthcare personnel and resources were
diverted to help with the Ebola response.
SHIGELLOSIS SPREADING IN U.S.
The Centers for Disease Control and Prevention
released a bulletin on the multidrug-resistant
Shigellosis currently spreading in the United States.
Nearly 90 percent of cases found have been resis-
tant to ciprofloxacin, the standard treatment for
shigellosis among adults in the United States. CDC
says these new infections emphasize the impor-
tance of using antibiotics wisely.
PA Jerin D. Bryant
PA Allendre Lindor
PHOTOCOURTESYOFHEALTHMONITOR
PHOTOCOURTESYOFALLENDRELINDOR

STAT | continued
COMPETITION HEATS UP FOR PAs
HealthLeaders Media reports that the convenient
care industry is quietly beefing up benefits and
looking for ways to entice PAs and NPs into joining
its ranks—potentially making it more challenging
for hospitals, health systems and physicians prac-
tices to retain PAs and NPs.
NEW GUIDELINES PRESSURE ULCER
PREVENTION AND TREATMENT
To prevent pressure ulcers, providers should first
do a risk assessment, and order an advanced static
mattress or an advanced static overlay for patients
at higher risk, according to new evidence-based
guidelines published in the Annals of Internal
Medicine. Researchers note that the advanced
static mattress and advanced static overlay are
also less likely to cause pressure ulcers, and are less
costly than the alternating air or low-air-loss mat-
tresses that are more often used. Alternating air
mattresses are also known as dynamic mattresses.
EDUCATING PATIENTS ABOUT OTCS
More than 240 million people rely on over-the-
counter (OTC) medicines to treat a broad range
of health ailments, and it’s important to know
how to use, store and dispose of them appropri-
ately, reports the CHPA Educational Foundation’s
KnowYourOTCs.org.
The foundation recently redesigned the
KnowYourOTCs.org website to give you the patient
information tools you need to teach patients how
to safely use, store and dispose of OTCs.
PA PENS NYT OP-ED ON DEATH
WITH DIGNITY
Oregon PA Barbara Coombs Lee wrote an Op-Ed
published in The New York Times about the
national end-of-life choice movement. She is the
coauthor of the Oregon Death With Dignity Act,
which allows mentally
competent, terminally
ill adults with less than
six months to live to
end their lives with
self-administered pre-
scribed medication.
A leading voice in the
movement, Coombs
Lee practiced as a nurse
and PA for 25 years
before becoming an
attorney and devoting her professional life to indi-
vidual choice and empowerment in healthcare.
Oregon was the first state to pass a death with
dignity law.
APPLY NOW FOR PEDERSEN
GLOBAL OUTREACH GRANT
The PA Foundation’s Robert K. Pedersen
Global Outreach grant program supports
the humanitarian efforts of PAs and PA
students who want to serve the under
served in the developing world, and the
U.S. applications are due May 15.
PA Barbara Coombs Lee
PHOTOCOURTESYOFCOMPASSION&CHOICES

STAT | continued
BELSOMRA is indicated for the treatment of insomnia characterized by difficulties with sleep onset
and/or sleep maintenance.
Selected Safety Information
BELSOMRA is contraindicated in patients with narcolepsy.
BELSOMRA contains suvorexant, a Schedule IV controlled substance.
BELSOMRA can impair daytime wakefulness. Central nervous system (CNS) depressant effects
can last for up to several days after discontinuation.
BELSOMRA can impair driving skills and may increase the risk of falling asleep while driving.
Caution patients taking BELSOMRA 20 mg against next-day driving and other activities requiring
full mental alertness.
Please see the adjacent Brief Summary of the Prescribing Information.
The only orexin receptor antagonist
for the treatment of insomnia
BELSOMRA is a highly selective antagonist for orexin receptors
• Blocking orexin receptors is thought to suppress wake drive.
• The therapeutic effect of BELSOMRA in insomnia is presumed to be through antagonism
of orexin receptors.
SOCIETY FOR EARLY CAREER PAs
The AAPA Board of Directors approved the Society for Early Career PAs (SECPA), as
a special interest group (SIG) for new PA grads. Informal groups recognized by the
Academy, SIGS are composed of individuals sharing a common goal or interest.
Josh Newton, PA-C, a 2011 graduate of Wake Forest University, and SECPA’s pri-
mary coordinator, said the group evolved from just talking about the future of the
profession with veteran and new PAs. He and other young PAs leaders began work-
ing with AAPA to form a group that would focus on this early career generation.
“I believe that early career PAs need a home,”said Newton, who is a PA in family
medicine.“AAPA has recently been focusing on the loss of PA members in the first
five years after graduation. I believe that this loss is because the PAs are joining
other communities that they feel better address and serve their needs. Some of the
leaders I specifically asked to help me build this organization have done just that. I
know these PAs are not leaving out of ill will towards AAPA, and I believe that AAPA
has the resources to meet their needs, but there is a disconnect. We hope that
SECPA will serve as a home for these PAs and create that community within AAPA
that addresses the changing needs of this generation.”
SECPA is focused on getting new PAs the professional development tools to
growth and thrive as clinicians and future leaders.
SECPA is also committed to early career PA advocacy at the national and state lev-
els in coordination with AAPA and its other constituent organizations (COs). Learn
more at a SECPA social hour at 6 p.m. on Sunday, May 24, 2014, at the Moscone
Convention Center. This open reception will be an opportunity to network with
other new PAs and learn more about SECPA. Contact PA Emilie Thornhill for more
information.
The Academy is proud to welcome SECPA as the 108th member of the CO
community!

1
1
1
6
3
2
1
PLACEBO
(n=767)
1
BELSOMRA
(20 mg in non-elderly patients
or 15 mg in elderly patients)
(n=493)
Gastrointestinal Disorders
Diarrhea
Dry mouth
Infections and Infestations
Upper respiratory tract infection
Nervous System Disorders
Headache
Somnolence
Dizziness
Psychiatric Disorders
Abnormal dreams
Respiratory, Thoracic, and Mediastinal Disorders
Cough
2
2
2
7
7
3
2
2
In 2 clinical trials with the 15-mg and 20-mg doses
BELSOMRA improved sleep onset
and sleep maintenance
In a clinical trial with the 10-mg dose
BELSOMRA improved sleep efficiency1
• Sleep efficiency is the percentage of time
in bed that is spent asleep.1
Help your patients fall asleep faster and
stay asleep longer with BELSOMRA®
(suvorexant)
Selected Safety Information (continued)
• Coadministration with other CNS depressants increases the risk of CNS depression. Patients should be advised
not to consume alcohol in combination with BELSOMRA due to additive effects. Dosage adjustments of
BELSOMRA and of other concomitant CNS depressants may be necessary when administered together because
of potentially additive effects. The use of BELSOMRA with other drugs to treat insomnia is not recommended.
• The risk of next-day impairment, including impaired driving, is increased if BELSOMRA is taken with less than
a full night of sleep remaining, if a higher than recommended dose is taken, if coadministered with other CNS
depressants, or if coadministered with other drugs that increase blood levels of BELSOMRA. Patients should be
cautioned against driving and other activities requiring complete mental alertness if taken in these circumstances.
• Reevaluate patients for comorbid conditions if insomnia persists after 7 to 10 days of treatment.
• A variety of cognitive and behavioral changes (eg, amnesia, anxiety, hallucinations, and other
neuropsychiatric symptoms) have been reported with the use of hypnotics such as BELSOMRA. Complex
behaviors such as “sleep-driving” (ie, driving while not fully awake after taking a hypnotic) and other
complex behaviors (eg, preparing and eating food, making phone calls, or having sex), with amnesia for the
event, have been reported in association with the use of hypnotics. Discontinuation of BELSOMRA should
be strongly considered for these patients. The use of alcohol and other CNS depressants may increase the
risk of such behaviors. These events can occur in hypnotic-naïve as well as hypnotic-experienced persons.
Discontinuation of BELSOMRA should be strongly considered for patients who report any complex sleep behavior.
• In clinical studies, a dose-dependent increase in suicidal ideation was observed in patients taking
BELSOMRA, as assessed by questionnaire. Immediately evaluate patients with suicidal ideation or any new
onset behavioral changes. Suicidal tendencies may be present and intentional overdose is more common in
this group of patients. Intentional overdose is more common in this group of patients; therefore, the lowest
number of tablets that is feasible should be prescribed for the patient at any one time.
Adverse reactions with BELSOMRA 15 mg or 20 mg
PERCENTAGE OF PATIENTS WITH ADVERSE REACTIONS OCCURRING AT AN INCIDENCE OF ≥2% AND
GREATER THAN PLACEBO IN 3-MONTH CONTROLLED EFFICACY TRIALS (STUDY 1 AND STUDY 2)
• The effect of BELSOMRA on respiratory function should be considered.
• Sleep paralysis, hypnagogic/hypnopompic hallucinations, and cataplexy-like
symptoms can occur. The risk of cataplexy-like symptoms increases with the
dose of BELSOMRA.
• BELSOMRA is not recommended for patients with severe hepatic impairment
or those taking a strong CYP3A inhibitor.
• Adverse reactions reported during long-term treatment up to 1 year were generally consistent with those
observed during the first 3 months of treatment.
• The adverse reaction profile in elderly patients was generally consistent with that of non-elderly patients.
• The incidence of discontinuation due to adverse reactions for patients treated with BELSOMRA 15 mg
or 20 mg was 3%, compared with 5% for placebo.
• There is evidence of a dose relationship for many of the adverse reactions associated with BELSOMRA use,
particularly for certain CNS adverse events.
Adverse reactions reported with BELSOMRA 10 mg (n=62)
• While no adverse reactions were reported at an incidence of ≥2% in patients treated with BELSOMRA 10 mg,
the types of reactions observed were similar to those observed in patients treated with BELSOMRA 20 mg.
• BELSOMRA was associated with a dose-related increase in somnolence: 2% at the 10-mg dose, 5% at the
20-mg dose, 12% at the 40-mg dose, and 11% at the 80-mg dose, compared with <1% for placebo.
• No patients discontinued BELSOMRA 10 mg due to an adverse reaction.1
In clinical trials
The only orexin receptor antagonist for insomnia

Copyright © 2015 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
All Rights Reserved. NEUR-1143278-0000 03/15
Reference: 1. Data available on request from Merck Professional Services-DAP, WP1, PO Box 4, West Point, PA 19486-0004. Please specify information package NEUR-1129587-0000.
• In clinical studies, the most common adverse reaction (reported in 5% or more of patients treated with 15 mg
or 20 mg of BELSOMRA and at least twice the placebo rate) was somnolence (BELSOMRA 7%, placebo 3%).
• The recommended dose of BELSOMRA is 5 mg in patients receiving moderate CYP3A inhibitors.
• Digoxin levels should be monitored, as slight increases were seen with coadministration of BELSOMRA.
• Patients should take BELSOMRA no more than once per night and within 30 minutes of going to bed,
with at least 7 hours remaining before the planned time of awakening.
• Use the lowest dose that is effective for the patient.
– The dose can be increased if well tolerated but not effective enough.
– The total dose of BELSOMRA should not exceed 20 mg once daily.
• Inform your patients about the importance of reading the Medication Guide.
Prescribe BELSOMRA for appropriate patients with insomnia—
so they can fall asleep faster and stay asleep longer
For appropriate adult patients with insomnia who have trouble falling asleep and/or staying asleep
If more efficacy is
needed and 10 mg
is well tolerated
Start with
10 mg
once nightly
Titrate to
15 mg once nightly
OR
20 mg once nightly
The total dose should not exceed 20 mg.
BELSOMRA can be taken nightly
Pills not actual size; for illustration purposes only.
To learn more information,
visit orexinreceptors.com
INDICATIONS AND USAGE
BELSOMRA is indicated for the treatment of insomnia characterized by difficulties with sleep onset
and/or sleep maintenance.
DOSAGE AND ADMINISTRATION
Dosing Information
Use the lowest dose effective for the patient.
The recommended dose for BELSOMRA is 10 mg, taken no more than once per night and within
30 minutes of going to bed, with at least 7 hours remaining before the planned time of awakening. If the
10-mg dose is well tolerated but not effective, the dose can be increased. The maximum recommended
dose of BELSOMRA is 20 mg once daily.
Special Populations
Exposure to BELSOMRA is increased in obese compared to non-obese patients, and in women compared
to men. Particularly in obese women, the increased risk of exposure-related adverse effects should be
considered before increasing the dose.
Use with CNS Depressants
When BELSOMRA is combined with other CNS depressant drugs, dosage adjustment of BELSOMRA
and/or the other drug(s) may be necessary because of potentially additive effects [see Warnings and
Precautions].
Use with CYP3A Inhibitors
The recommended dose of BELSOMRA is 5 mg when used with moderate CYP3A inhibitors and the dose
generally should not exceed 10 mg in these patients. BELSOMRA is not recommended for use with strong
CYP3A inhibitors [see Drug Interactions].
Food Effect
Time to effect of BELSOMRA may be delayed if taken with or soon after a meal.
DOSAGE FORMS AND STRENGTHS
• 5-mg tablets are yellow, round, film-coated tablets with “5” on one side and plain on the other side.
• 10-mg tablets are green, round, film-coated tablets with “33” on one side and plain on the other side.
• 15-mg tablets are white, oval, film-coated tablets with the Merck logo on one side and “325” on the
other side.
• 20-mg tablets are white, round, film-coated tablets with the Merck logo and “335” on one side and
plain on the other side.
CONTRAINDICATIONS
BELSOMRA is contraindicated in patients with narcolepsy.
WARNINGS AND PRECAUTIONS
CNS Depressant Effects and Daytime Impairment
BELSOMRA is a central nervous system (CNS) depressant that can impair daytime wakefulness even
when used as prescribed. Prescribers should monitor for somnolence and CNS depressant effects, but
impairment can occur in the absence of symptoms, and may not be reliably detected by ordinary clinical
exam (i.e., less than formal testing of daytime wakefulness and/or psychomotor performance). CNS
depressant effects may persist in some patients for up to several days after discontinuing BELSOMRA.
BELSOMRA can impair driving skills and may increase the risk of falling asleep while driving. Discontinue
or decrease the dose in patients who drive if daytime somnolence develops. In a study of healthy adults,
driving ability was impaired in some individuals taking BELSOMRA 20 mg. Although pharmacodynamic
tolerance or adaptation to some adverse depressant effects of BELSOMRA may develop with daily use,
patients using the 20-mg dose of BELSOMRA should be cautioned against next-day driving and other
activities requiring full mental alertness. Patients taking lower doses of BELSOMRA should also be
cautioned about the potential for driving impairment because there is individual variation in sensitivity
to BELSOMRA.
Coadministration with other CNS depressants (e.g., benzodiazepines, opioids, tricyclic antidepressants,
alcohol) increases the risk of CNS depression. Patients should be advised not to consume alcohol in
combination with BELSOMRA because of additive effects [see Drug Interactions]. Dosage adjustments
of BELSOMRA and of concomitant CNS depressants may be necessary when administered together
because of potentially additive effects. The use of BELSOMRA with other drugs to treat insomnia is not
recommended [see Dosage and Administration].
The risk of next-day impairment, including impaired driving, is increased if BELSOMRA is taken with less
than a full night of sleep remaining, if a higher than the recommended dose is taken, if coadministered
with other CNS depressants, or if coadministered with other drugs that increase blood levels of
BELSOMRA. Patients should be cautioned against driving and other activities requiring complete mental
alertness if BELSOMRA is taken in these circumstances.
Need to Evaluate for Comorbid Diagnoses
Because sleep disturbances may be the presenting manifestation of a physical and/or psychiatric disorder,
treatment of insomnia should be initiated only after careful evaluation of the patient. The failure of insomnia
to remit after 7 to 10 days of treatment may indicate the presence of a primary psychiatric and/or medical
illness that should be evaluated. Worsening of insomnia or the emergence of new cognitive or behavioral
abnormalities may be the result of an unrecognized underlying psychiatric or physical disorder, and can
emerge during the course of treatment with hypnotic drugs such as BELSOMRA.
Abnormal Thinking and Behavioral Changes
A variety of cognitive and behavioral changes (e.g., amnesia, anxiety, hallucinations and other
neuropsychiatric symptoms) have been reported to occur in association with the use of hypnotics such
as BELSOMRA. Complex behaviors such as “sleep-driving” (i.e., driving while not fully awake after taking
a hypnotic) and other complex behaviors (e.g., preparing and eating food, making phone calls, or having
sex), with amnesia for the event, have been reported in association with the use of hypnotics. These
events can occur in hypnotic-naïve as well as in hypnotic-experienced persons. The use of alcohol and
other CNS depressants may increase the risk of such behaviors. Discontinuation of BELSOMRA should
be strongly considered for patients who report any complex sleep behavior.
Worsening of Depression/Suicidal Ideation
In clinical studies, a dose-dependent increase in suicidal ideation was observed in patients taking
BELSOMRA as assessed by questionnaire. Immediately evaluate patients with suicidal ideation or any
new behavioral sign or symptom.
In primarily depressed patients treated with sedative-hypnotics, worsening of depression, and suicidal
thoughts and actions (including completed suicides) have been reported. Suicidal tendencies may be
present in such patients and protective measures may be required. Intentional overdose is more common
in this group of patients; therefore, the lowest number of tablets that is feasible should be prescribed for
the patient at any one time.
The emergence of any new behavioral sign or symptom of concern requires careful and immediate
evaluation.
Patients with Compromised Respiratory Function
Effect of BELSOMRA®
(suvorexant) on respiratory function should be considered if prescribed to patients
with compromised respiratory function. BELSOMRA has not been studied in patients with severe
obstructive sleep apnea (OSA) or severe chronic obstructive pulmonary disease (COPD) [see Use in
Specific Populations].
Sleep Paralysis, Hypnagogic/Hypnopompic Hallucinations, Cataplexy-like Symptoms
Sleep paralysis, an inability to move or speak for up to several minutes during sleep-wake transitions, and
hypnagogic/hypnopompic hallucinations, including vivid and disturbing perceptions by the patient, can
occur with the use of BELSOMRA. Prescribers should explain the nature of these events to patients when
prescribing BELSOMRA.
Symptoms similar to mild cataplexy can occur, with risk increasing with the dose of BELSOMRA. Such
symptoms can include periods of leg weakness lasting from seconds to a few minutes, can occur both
at night and during the day, and may not be associated with an identified triggering event (e.g., laughter
or surprise).
ADVERSE REACTIONS
The following serious adverse reactions are discussed in greater detail in other sections:
• CNS depressant effects and daytime impairment [see Warnings and Precautions]
• Abnormal thinking and behavioral changes [see Warnings and Precautions]
• Worsening of depression/suicidal ideation [see Warnings and Precautions]
• Sleep paralysis, hypnagogic/hypnopompic hallucinations, cataplexy-like symptoms [see Warnings
and Precautions]
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in
the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and
may not reflect the rates observed in clinical practice.
In 3-month controlled efficacy trials (Study 1 and Study 2), 1,263 patients were exposed to BELSOMRA,
including 493 patients who received BELSOMRA 15 mg or 20 mg (see Table 1).
In a long-term study, additional patients (n=521) were treated with BELSOMRA at higher than
recommended doses, including a total of 160 patients who received BELSOMRA for at least one year.
Table 1:
Patient Exposure to BELSOMRA 15 mg or 20 mg in Study 1 and Study 2
The pooled safety data described below (see Table 2) reflect the adverse reaction profile during the first
3 months of treatment.
Adverse Reactions Resulting in Discontinuation of Treatment
The incidence of discontinuation due to adverse reactions for patients treated with 15 mg or 20 mg of
BELSOMRA was 3% compared to 5% for placebo. No individual adverse reaction led to discontinuation at
an incidence ≥1%.
Most Common Adverse Reactions
In clinical trials of patients with insomnia treated with BELSOMRA 15 mg or 20 mg, the most common
adverse reaction (reported in 5% or more of patients treated with BELSOMRA and at least twice the
placebo rate) was somnolence (BELSOMRA 7%; placebo 3%).
Table 2 shows the percentage of patients with adverse reactions during the first 3 months of treatment,
based on the pooled data from 3-month controlled efficacy trials (Study 1 and Study 2).
At doses of 15 mg or 20 mg, the incidence of somnolence was higher in females (8%) than in males (3%).
Of the adverse reactions reported in Table 2, the following occurred in women at an incidence of at least
twice that in men: headache, abnormal dreams, dry mouth, cough, and upper respiratory tract infection.
The adverse reaction profile in elderly patients was generally consistent with non-elderly patients. The
adverse reactions reported during long-term treatment up to 1 year were generally consistent with those
observed during the first 3 months of treatment.
Table 2:
Percentage of Patients with Adverse Reaction Incidence ≥2% and Greater than Placebo
in 3-Month Controlled Efficacy Trials (Study 1 and Study 2)
Patients Treated BELSOMRA BELSOMRA
15 mg 20 mg
For ≥1 Day (n) 202 291
Men (n) 69 105
Women (n) 133 186
Mean Age (years) 70 45
For ≥3 Months (n) 118 172
BELSOMRA®
(suvorexant) 5-, 10-, 15-, 20-mg tablets, for oral use, C-IV
BRIEF SUMMARY OF PRESCRIBING INFORMATION
Placebo BELSOMRA
(20 mg in non-elderly or
15 mg in elderly patients)
n=767 n=493
Gastrointestinal Disorders
Diarrhea 1 2
Dry mouth 1 2
Infections and Infestations
Upper respiratory tract infection 1 2
Nervous System Disorders
Headache 6 7
Somnolence 3 7
Dizziness 2 3
Psychiatric Disorders
Abnormal dreams 1 2
Respiratory, Thoracic, and Mediastinal Disorders
Cough 1 2

Dose Relationship for Adverse Reactions
There is evidence of a dose relationship for many of the adverse reactions associated with
BELSOMRA®
(suvorexant) use, particularly for certain CNS adverse reactions.
In a placebo-controlled crossover study (Study 3), non-elderly adult patients were treated for up to 1
month with BELSOMRA at doses of 10 mg, 20 mg, 40 mg (2 times the maximum recommended dose),
or 80 mg (4 times the maximum recommended dose). In patients treated with BELSOMRA 10 mg (n=62),
although no adverse reactions were reported at an incidence of ≥2%, the types of adverse reactions
observed were similar to those observed in patients treated with BELSOMRA 20 mg. BELSOMRA was
associated with a dose-related increase in somnolence: 2% at the 10-mg dose, 5% at the 20-mg dose,
12% at the 40-mg dose, and 11% at the 80-mg dose, compared to <1% for placebo. BELSOMRA was also
associated with a dose-related increase in serum cholesterol: 1 mg/dL at the 10-mg dose, 2 mg/dL at the
20-mg dose, 3 mg/dL at the 40-mg dose, and 6 mg/dL at the 80-mg dose after 4 weeks of treatment,
compared to a 4 mg/dL decrease for placebo.
DRUG INTERACTIONS
CNS-Active Agents
When BELSOMRA was coadministered with alcohol, additive psychomotor impairment was demonstrated.
There was no alteration in the pharmacokinetics of BELSOMRA [see Warnings and Precautions].
Effects of Other Drugs on BELSOMRA
Metabolism by CYP3A is the major elimination pathway for suvorexant.
CYP3A Inhibitors
Concomitant use of BELSOMRA with strong inhibitors of CYP3A (e.g., ketoconazole, itraconazole,
posaconazole, clarithromycin, nefazodone, ritonavir, saquinavir, nelfinavir, indinavir, boceprevir, telaprevir,
telithromycin, and conivaptan) is not recommended.
The recommended dose of BELSOMRA is 5 mg in subjects receiving moderate CYP3A inhibitors
(e.g., amprenavir, aprepitant, atazanavir, ciprofloxacin, diltiazem, erythromycin, fluconazole, fosamprenavir,
grapefruit juice, imatinib, and verapamil). The dose can be increased to 10 mg in these patients if
necessary for efficacy.
CYP3A Inducers
Suvorexant exposure can be substantially decreased when coadministered with strong CYP3A inducers
(e.g., rifampin, carbamazepine, and phenytoin). The efficacy of BELSOMRA may be reduced.
Effects of BELSOMRA on Other Drugs
Digoxin
Concomitant administration of BELSOMRA with digoxin slightly increased digoxin levels due to inhibition
of intestinal P-gp. Digoxin concentrations should be monitored when coadministering BELSOMRA with
digoxin.
USE IN SPECIFIC POPULATIONS
Pregnancy
Pregnancy Category C
There are no adequate and well-controlled studies in pregnant women. BELSOMRA should be used during
pregnancy only if the potential benefit justifies the potential risk to the fetus. Administration of suvorexant
to pregnant rats throughout organogenesis in two separate studies at oral doses of 30, 150, and
1,000 mg/kg or 30, 80, and 325 mg/kg resulted in a decrease in fetal body weight at doses greater than
80 mg/kg. Plasma exposures (AUC) at the no-effect dose were approximately 25 times that in humans at
the maximum recommended human dose (MRHD) of 20 mg/day.
Administration of suvorexant to pregnant rabbits throughout organogenesis in two separate studies at oral
doses of 40, 100, and 300 mg/kg or 50, 150, and 325 mg/kg resulted in no apparent adverse effects on
embryo-fetal development. Excessive toxicity resulted in premature sacrifice of pregnant animals at
325 mg/kg. The highest maternal plasma exposures (AUC) for which there are fetal data were up to
approximately 40 times that in humans at the MRHD.
Administration of suvorexant (oral doses of 30, 80, and 200 mg/kg) to pregnant rats throughout gestation
and lactation resulted in decreased body weight in offspring at the highest dose tested. Plasma AUCs at
the no-effect dose were approximately 25 times that in humans at the MRHD.
Nursing Mothers
Suvorexant and a hydroxyl-suvorexant metabolite were excreted in rat milk at levels higher (9 and
1.5 times, respectively) than that in maternal plasma. It is not known whether this drug is secreted
in human milk. Because many drugs are excreted in human milk, caution should be exercised when
BELSOMRA is administered to a nursing woman.
Pediatric Use
Safety and effectiveness in pediatric patients have not been established.
Geriatric Use
Of the total number of patients treated with BELSOMRA (n=1,784) in controlled clinical safety and efficacy
studies, 829 patients were 65 years and over, and 159 patients were 75 years and over. No clinically
meaningful differences in safety or effectiveness were observed between these patients and younger
patients at the recommended doses.
Patients with Compromised Respiratory Function
Effects of BELSOMRA on respiratory function should be considered if prescribed to patients with
compromised respiratory function.
Obstructive Sleep Apnea
The respiratory depressant effect of BELSOMRA was evaluated after 1 night and after 4 consecutive
nights of treatment in a randomized, placebo-controlled, 2-period crossover study in patients (n=26)
with mild to moderate obstructive sleep apnea. Following once-daily doses of 40 mg, the mean
Apnea/Hypopnea Index treatment difference (suvorexant – placebo) on Day 4 was 2.7 (90% CI: 0.22
to 5.09), but there was wide inter- and intra-individual variability such that clinically meaningful respiratory
effects of BELSOMRA in obstructive sleep apnea cannot be excluded. BELSOMRA has not been studied in
patients with severe obstructive sleep apnea [see Warnings and Precautions].
Chronic Obstructive Pulmonary Disease
The respiratory depressant effect of BELSOMRA was evaluated after 1 night and after 4 consecutive
nights of treatment in a randomized, placebo-controlled, 2-period crossover study in patients (n=25)
with mild to moderate chronic obstructive pulmonary disease (COPD). BELSOMRA (40 mg in non-elderly,
30 mg in elderly) had no respiratory depressant effects in patients with mild to moderate COPD, as
measured by oxygen saturation. There was wide inter- and intra-individual variability such that clinically
meaningful respiratory effects of BELSOMRA in COPD cannot be excluded. BELSOMRA has not been
studied in patients with severe COPD [see Warnings and Precautions].
Patients with Hepatic Impairment
No dose adjustment is required in patients with mild and moderate hepatic impairment. BELSOMRA has
not been studied in patients with severe hepatic impairment and is not recommended for these patients.
Patients with Renal Impairment
No dose adjustment is required in patients with renal impairment.
DRUG ABUSE AND DEPENDENCE
Controlled Substance
BELSOMRA®
(suvorexant) contains suvorexant, a Schedule IV controlled substance.
Abuse
Abuse of BELSOMRA poses an increased risk of somnolence, daytime sleepiness, decreased reaction
time, and impaired driving skills [see Warnings and Precautions]. Patients at risk for abuse may include
those with prolonged use of BELSOMRA, those with a history of drug abuse, and those who use
BELSOMRA in combination with alcohol or other abused drugs.
Drug abuse is the intentional non-therapeutic use of an over-the-counter or prescription drug, even once,
for its rewarding psychological or physiological effects. Drug addiction is a cluster of behavioral, cognitive,
and physiological phenomena that may develop after repeated abuse of a prescription or over-the-counter
drug, including: a strong desire to take the drug, difficulties in controlling drug use, persisting in drug use
despite harmful consequences, a higher priority given to drug use than to other activities and obligations,
as well as the possibility of the development of tolerance or development of physical dependence (as
manifest by a withdrawal syndrome). Drug abuse and drug addiction are separate and distinct from
physical dependence and tolerance (for example, abuse or addiction are not always accompanied by
tolerance or physical dependence).
In an abuse liability study conducted in recreational polydrug users (n=36), suvorexant (40, 80, and
150 mg) produced similar effects as zolpidem (15, 30 mg) on subjective ratings of “drug liking” and other
measures of subjective drug effects. Because individuals with a history of abuse or addiction to alcohol or
other drugs may be at increased risk for abuse and addiction to BELSOMRA, follow such patients carefully.
Dependence
Physical dependence is a state that develops as a result of physiological adaptation in response to
repeated drug use. Physical dependence manifests by drug class-specific withdrawal symptoms
after abrupt discontinuation or a significant dose reduction of a drug. In completed clinical trials with
BELSOMRA, there was no evidence for physical dependence with the prolonged use of BELSOMRA. There
were no reported withdrawal symptoms after discontinuation of BELSOMRA.
OVERDOSAGE
There is limited premarketing clinical experience with an overdosage of BELSOMRA. In clinical
pharmacology studies, healthy subjects who were administered morning doses of up to 240 mg of
suvorexant showed dose-dependent increases in the frequency and duration of somnolence.
General symptomatic and supportive measures should be used, along with immediate gastric lavage
where appropriate. Intravenous fluids should be administered as needed. As in all cases of drug overdose,
vital signs should be monitored and general supportive measures employed. The value of dialysis in the
treatment of overdosage has not been determined. As suvorexant is highly protein-bound, hemodialysis is
not expected to contribute to elimination of suvorexant.
As with the management of all overdosage, the possibility of multiple drug ingestion should be considered.
Consider contacting a poison control center for up-to-date information on the management of hypnotic
drug product overdosage.
CLINICAL STUDIES
Special Safety Studies
Effects on Driving
Two randomized, double-blind, placebo- and active-controlled, 4-period crossover studies evaluated the
effects of nighttime administration of BELSOMRA on next-morning driving performance 9 hours after
dosing in 24 healthy elderly subjects (≥65 years old, mean age 69 years; 14 men, 10 women) who
received BELSOMRA 15 mg and 30 mg, and 28 non-elderly subjects (mean age 46 years; 13 men,
15 women) who received BELSOMRA 20 mg and 40 mg. Testing was conducted after 1 night and after
8 consecutive nights of treatment with BELSOMRA at these doses.
The primary outcome measure was change in Standard Deviation of Lane Position (SDLP), a measure of
driving performance, assessed using a symmetry analysis. The analysis showed clinically meaningful
impaired driving performance in some subjects. After 1 night of dosing, this effect was observed in
non-elderly subjects after either a 20-mg or 40-mg dose of BELSOMRA. A statistically significant effect
was not observed in elderly subjects after a 15-mg or 30-mg dose of BELSOMRA. Across these 2 studies,
5 subjects (4 non-elderly women on BELSOMRA; 1 elderly woman on placebo) prematurely stopped
their driving tests due to somnolence. Patients using the 20-mg dose of BELSOMRA should be cautioned
against next-day driving and other activities requiring full mental alertness. Patients taking lower doses of
BELSOMRA should also be cautioned about the potential for driving impairment because there is individual
variation in sensitivity to BELSOMRA [see Warnings and Precautions].
Effects on Next-day Memory and Balance in Elderly and Non-elderly
Four placebo-controlled trials evaluated the effects of nighttime administration of BELSOMRA on next-day
memory and balance using word learning tests and body sway tests, respectively. Three trials showed
no significant effects on memory or balance compared to placebo. In a fourth trial in healthy non-elderly
subjects, there was a significant decrease in word recall after the words were presented to subjects in the
morning following a single dose of BELSOMRA 40 mg, and there was a significant increase on body sway
area in the morning following a single dose of BELSOMRA 20 mg or 40 mg.
Middle of the Night Safety in Elderly Subjects
A double-blind, randomized, placebo-controlled trial evaluated the effect of a single dose of BELSOMRA on
balance, memory, and psychomotor performance in healthy elderly subjects (n=12) after being awakened
during the night. Nighttime dosing of BELSOMRA 30 mg resulted in impairment of balance (measured by
body sway area) at 90 minutes as compared to placebo. Memory was not impaired, as assessed by an
immediate and delayed word recall test at 4 hours post-dose.
For patent information: merck.com/product/patent/home.html
Copyright © 2015 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
All rights reserved. NEUR-1143278-0000 03/15
For more detailed information, please read the
Prescribing Information.
USPI-MK4305-T-1408R001
Revised: 08/2014
Physician Assistant Program
Proud to be Educating
the Next Generation
of PHYSICIAN ASSISTANTS
www.LMUnet.edu/dcom
Earn your degree in 27 months.
Learn in a state-of-the art medical school.

COVER STORY
S
aying medicine ain’t what it used to be is a bit of an understatement.
There are more patients, with more complex conditions; the team-
based care model is becoming the standard; value-based reimburse-
ment is a game-changer; the marketplace and technology are driving
industry-wide transformation; and patients’expectations and needs are
different.
The really great news is PAs are trending up. More and more patients,
employers, third-party payers, policymakers and lawmakers recognize the
value of PAs. A few months ago AAPA commissioned Harris Poll to do a
nationwide benchmark survey of consumer attitudes about PAs, and the
study confirmed an exciting, statistically significant fact: America loves PAs!
Further, a recent survey by PriceWaterhouseCoopers found that 75 percent
of all consumers are comfortable with the expanding role of PAs and NPs.
So what now? What happens when AAPA asks health system and staffing
agency executives to“Imagine What’s Next”for the PA profession? PA Pro-
fessional talked about just that with Tyler Black, vice president of Advanced
Practice Staffing for CompHealth/CHG Healthcare, a locum tenens staffing
agency headquartered in Salt Lake City, Utah; Suzanne Onorato, PhD, exec-
utive director of the cardiovascular service line for Saint Francis Hospital
and Medical Center in Hartford, Conn.; Robert Probe, MD, chairman of the
Scott & White Clinic Board of Directors, a part of Baylor Scott & White
Health, the largest nonprofit healthcare system in Texas; and Will Rubinow,
managing director of Lyle Health, a division of The Lyle Group, LLC, a staff-
ing firm in Farmington, Conn.
These health system and staffing agency executives had a lot to say
about the obstacles, challenges and successes that they and their clients
have seen through years of working with and placing PAs. And the take-
away is that PAs will be in demand well into the future, mainly because they
are the answer to several problems plaguing the healthcare system.
IMAGINE
WHAT’S NEXT
FOR THE PA PROFESSION
Experts onWhat the Future Holds
BY JENNIFER L. WALKER

COVER STORY | continued
What has been your experience, or your
client’s experience, working with/hiring PAs,
and where do you think you’ve succeeded
organizationally with PAs on staff?
TYLER BLACK: Our business has grown pretty aggressively over the last
10 years in the physician assistant world. Some of the feedback we get
from our clients is improved patient satisfaction and [the ability] to balance
work-life for their physicians. My primary care provider is also a physician
assistant. I can always get in to see her, and she provides sound clinical
results and a great patient experience for my family and me.
WILL RUBINOW: We place PAs with hospitals, private practices and
multispecialty groups on a daily basis, which I think is pretty impactful.
SUZANNE ONORATO: Within the cardiovascular service line at Saint
Francis, we have approximately 30 PAs divided into three dedicated teams:
heart failure, medical cardiology and CV surgery. We support the PAs to
work to the full scope of their license. Our model in cardiology is predomi-
nately a private practice model, so the PAs help standardize care across the
different private practice groups in order to support the hospital needs for
regulatory, documentation, and quality requirements.
ROBERT PROBE: [At Scott & White Healthcare], the history is probably
a 20-year history. [PAs] started off in support of surgical specialties, and it
became a program that we grew fairly rapidly over the next years into
primary care clinics … [More recently], about 18 months ago, Scott & White
merged with Baylor Health Care System. [Now] I think we’re evolving into
something where a big group, let’s say orthopaedics, is going to have a
lead APP [advanced practice professional, which includes PAs and
advanced practice nurses]. PAs will report to that lead APP, who will be
responsible for annual evaluations and for communicating objectives and
goals of the organization. The APPs [then] become just as engaged a work-
force as the physician workforce. This is just a concept at this point, but one
that I think will almost certainly be endorsed.
BLACK ONORATO PROBE
PHOTOCOURTESYOFCHGHEALTHCARE,SAINTFRANCISHOSPITAL
ANDMEDICALCENTER,BAYLORSCOTT&WHITEHEALTH

What are the obstacles/challenges you,
or your clients, see with employing PAs?
PROBE: I think our pay scales have been off. We plan to rectify that with
a little bit of a salary bump.
ONORATO: One anticipated challenge is a growth in the utilization of
PAs across the healthcare system, which may create a shortage of PAs
nationally, as well as more competition for the top candidates.
RUBINOW: The billing and reimbursement process for PAs is not as lucid
as it could be. When a PA sees a patient, they’re obviously freeing up the
physician to do something else that could be revenue producing. That
revenue isn’t seen on the bottom line.
BLACK: [We] have a fair amount of clients who are looking to utilize a
physician assistant for the first time and there is certainly a lack of under-
standing about utilization. That creates a lot of opportunity for education.
CME Symposium on Hospital
Management for PAs
Y
ou are invited to join an AAPA Center for Healthcare
Leadership and Management CME symposium on
hospital management designed for PA executives
and PAs aspiring to become one. This groundbreaking event
will be held during AAPA Conference 2015 in San Francisco from
10 a.m. − 5:30 p.m. on Sunday, May 24, at the San Francisco
Marriott Marquis. Lunch will be provided.
Topics include:
● Challenges facing healthcare
● Developing leadership
● Recruiting and retaining PAs
● Maximizing reimbursement
● Operationalizing quality and value
A networking reception will follow this all-day symposium
from 5:30 – 6:30 p.m. If you are attending conference, the
Symposium is free. If you are not attending conference, regis-
tration is $165 for AAPA members or $195 for nonmembers.
Space is limited so RSVP to the AAPA Center for Healthcare
Leadership and Management by May 18.
The AAPA Center for Healthcare Leadership and Management
(CHLM) provides advisory services, programs and expertise on
optimizing PA practice. CHLM offers PAs professional develop-
ment resources geared towards leadership and management
skills in the healthcare setting.

What kinds of issues do you, or your clients,
deal with surrounding PAs and scope of
practice/regulatory compliance?
BLACK: [Scope of practice] is so variable by state, what a PA can or can’t
do in certain work settings or certain geographic locations, so a lot of our
clients may be underutilizing their physician assistant staff based on a lack
of understanding. They’re reaching out to us to help them identify
resources that can educate them.
Are you able to articulate the value of PAs
from a monetization standpoint?
BLACK: In primary care settings, the physician assistant can do around
70 percent of the in-office procedures and services that a physician could
provide, and they’re doing it at somewhere around half the investment.
ONORATO: There are many indirect monetary benefits by having PAs.
In addition to supporting our quality and regulatory requirements, our
PAs provide 24/7 coverage creating a safety net for our patients. They’re
another set of eyes, another set of hands on patients. Because of that, the
PAs support a safer environment for our patients, and better patient out-
comes are ultimately more cost effective.
PROBE: We went through an initiative called Same Day Access, where
we were making the commitment to our patients that if you wanted to be
seen today, we could see you today. That would have been completely
impossible without PAs and nurse practitioners. [Also], from an economic
standpoint in a hospital, as soon as a patient is ready to be discharged,
having somebody there that’s constantly available to discharge just in
time, if you will, has been effective at keeping our length of stay down.
How are you, or your clients, adding PAs to
your workforce and are you using them in
subspecialty areas?
BLACK: Around 2006 or 2007, about 80 percent of our business was in a
primary care setting. Today, that [figure] is substantially less. In every spe-
cialty, we’re starting to see more demand for physician assistants.
RUBINOW: The demand for PAs is out there. The busiest specialties
include orthopaedics, cardiothoracic, neurosurgery and general surgery.
We are also seeing a pick-up for PA demand in family medicine, ENT
and gastro.

How big of an issue is PA recruitment/
retention?
BLACK: Every organization we work with struggles with recruitment. The
physician assistant is a unique position. They’re trained on a broad scope
and then go into a certain specialty after their education. So finding the
right person with the right skillset is a challenge. As you start to see utiliza-
tion expand over multiple specialties, those people become even more
difficult to find. Hospitals just aren’t equipped with the resources to specifi-
cally identify and find those people.
PROBE: I think retention is a big issue. If APPs take a year to become
well-trained, and they are with you for two to three years, well, that’s a
cycle of education. Just when you educate them and they’re really good
and effective in their practice, then they leave, and you’ve got to start that
educational process all over again. So that’s a bit of a struggle. That’s why
we’re giving so much thought and energy and really investment into com-
ing up with a PA governance structure that makes them feel engaged with
the organization and hopefully become long-term employees.
Tell us about the PA governance at your
organization. Are PAs also included on your
medical staff committees?
PROBE: To give them a seat at the table, we created the APP Council.
There are about 15 people on the council … all elected positions. It has
been operational for five or six years with representation from all over our
30,000 square miles. We hear from the regions about best practices regard-
ing PA utilization. [APPs also] sit in on our credentialing committee respon-
sible for credentialing and privileging PAs. [And] the director of the APPs
actually comes to our physician board meetings, as a nonvoting member,
but who is there and present.
Are there things other hospital administrators
and physicians don’t “get” about PAs that
become a source of frustration?
BLACK: It’s so dependent on the different organizations we work with.
I think a lot of them still don’t understand reimbursement and utilization
like they should.
RUBINOW: The only thing that is frustrating is when a practice doesn’t
realize the impact a PA can have, not only on their practice, but with their
patients. If I were an orthopaedic surgeon and I had my own practice, I’d
have two PAs for every doc because there’s so much they can do. But
there’s still a lack of education among the physician community about
how a PA can add to their practice.

JENNIFER L. WALKER is a
Baltimore-based freelance
writer. She is a regular
contributor to PA Professional.
What do you think the future holds for PA
utilization in healthcare?
PROBE: As we move to things like patient-centered medical homes,
I think it’s going to be more team-based care, so perhaps a physician over-
seeing two or three APPs. Our system goal is to move toward capitation,
that is to provide a high level of care, but hopefully at a lower cost. And
I think the employment of APPs is a great opportunity to do that.
RUBINOW: The bottom line is there is a shortage of physicians—
surgeons, family practice, primary care—over the next 10, 15, 20 years,
and there has to be a way to address that so that people can have access
to healthcare. And I think the way you’re going to see that [gap filled] is
through physician assistants. I think you’ll also see more PA programs open
throughout the country.
BLACK: We think the market [for PAs] will continue to expand at a rela-
tively aggressive pace. Physician assistants can be picky about where they
work. They can really focus on working for quality employers. We’re [also]
excited that there’s starting to become a real understanding of the value
of the physician assistant profession. Whatever level of professional you’re
talking to about healthcare as a whole, it’s rare that they don’t mention a
physician assistant or a nurse practitioner as being a big part of the solu-
tion to [the problems] of accessibility and quality.

MPAS Degree Advancement Option
Division of Physician Assistant Education
Requirements
§ Graduate of accredited PA program and possess
a baccalaureate degree
§ Current or prior NCCPA certification
§ Physician/Mentor who agrees to be your preceptor
Learn more and apply at:
unmc.edu/alliedhealth/padao.htm | 402-559-6673
Program Highlights
§ Over 30 years of proven success granting
master’s degrees to nearly 2000 practicing PAs
§ 36 semester credit hours of courses including
a clinical or education track
§ Affordable program with no required resident
time on the UNMC campus
§ Graduate in 5 semesters with up to 5 years to
complete studies
References: 1. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2014-15 Edition, Physician Assistants, on the Internet at http://www.bls.gov/ooh/healthcare/physician-assistants.
htm (visited March 05, 2015). 2. Expanding Access to Primary Care: The Role of Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives in the Health Center Workforce. National Association of Community
Health Centers website. http://www.nachc.com/client/documents/Workforce_FS_0913.pdf. Accessed November 11, 2014. 3. NSAIDs and Renal Toxicity in the Community Setting. The Institute for Continuing Healthcare
Education website. http://www.iche.edu/pain2/ painarticle2.pdf. Accessed November 11, 2014. 4. Alliance for the Rationale Use of NSAIDs. Data on file. 5. Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley
TJ, et al. Adverse drug reactions as a cause for admission to hospital: prospective analysis of 18 820 patients. BMJ 2004;329: 15-9. (3 July.) ©2015. Western Pain Society. All rights reserved.
RISING TO THE CHALLENGES OF PRIMARY CARE AND
APPROPRIATE NSAID USE
MEMBERS OF THE ALLIANCE INCLUDE
SUPPORTED BY
The demand for physician assistants (PAs) and
their primary care services has never been higher.
Approximately 40,000 PAs in the United States
practice primary care.1
By utilizing staffing models
that include PAs, health care facilities are better
able to offer patients access to comprehensive
primary and preventative care services.2
A common but challenging condition managed in
primary care is pain. Perhaps more than any other
condition, pain may be managed by the clinician
and/or by the patient, which can compound care.
For example, many patients take over–the-counter
(OTC) non-steroidal anti-inflammatory drugs
(NSAIDs) to manage pain, and clinicians may be
unaware of OTC NSAID use. NSAIDs represent
approximately 60% of OTC analgesic agents used
in the United States.3
In addition, approximately
5% of the US population uses a prescription
NSAID.4
Although NSAID use is ubiquitous, many
patients are unfamiliar with the class name and do
not know which products are NSAIDs or contain
NSAIDs in combination with other agents.4
Data on
national patterns of NSAID use show that 26% to
44% of individuals are consuming more NSAIDs
than they should.3,4
In addition to individual risk
stratification, the medical literature demonstrates
that NSAID-related adverse events are dose and
duration dependent, and there are potentially
serious risks associated with their improper
use. For example, a British study concluded that
12% of medication-related preventable hospital
admissions were related to use of NSAIDs.5
These facts place primary care clinicians, like PAs,
at the critical intersections of diagnosis, treatment,
and patient education. It is important for all HCPs,
including PAs, to educate patients about how to
take NSAIDs in a responsible way that provides
a therapeutic benefit while minimizing risks. This
means that PAs not only need to know how to
manage pain but also must make sure they ask
the questions and get the information needed
to make sound decisions and best educate their
patients. Asking about how patients manage pain
and making NSAID use a standard part of any
medication history and reconciliation process can
lessen the likelihood of a serious NSAID-related
adverse event. Similarly, reminding patients to
take one NSAID at a time at the lowest effective
dose for the shortest duration of time required can
help ensure the safest and most appropriate way
to manage pain with OTC or prescription NSAID
medications.
To address this important issue, the Alliance for
Rationale Use of NSAIDs is proud to announce
that it is partnering with the American Academy
of Physician Assistants (AAPA) over the
coming months to offer a comprehensive NSAID
awareness program with educational resources
and patient support materials.
WHEN PRESCRIBING NSAIDS:
The Alliance for the Rational Use of NSAIDs – A Public Health
Coalition – aims to bridge the gap between guidance and clinical
practice, educating health care professionals and the public at
large to ensure appropriate and safe use of NSAIDs.
To download educational materials and learn more about the Alliance
for Rationale Use of NSAIDs, visit www.NSAIDAlliance.com.

Leading by Example
From the Patient’s Room to the Boardroom
BY CHERISE CARRERA
“It’s 24/7.” That’s how Laurie Benton, PhD, MPAS,
PA-C, RN, DFAAPA, described her posi-
tion as system director, advanced practice professionals, at Baylor Scott &
White Health (BSWH), the largest nonprofit healthcare system in Texas and
one of the largest in the United States.
“I’m running out of hours in the day because the needs for the role just
keep growing and growing,”said Benton.“I’m always available for my peers
or my preceptors: They have my cell phone and my pager numbers. You
have to be dedicated to your peers.”
It’s that kind of dedication, among other qualities, that made Benton
stand out from the crowd when, 15 years ago, she began working as a PA
in critical care and cardiothoracic surgery at Scott & White Healthcare, one-
half of the entities that would go on to form BSWH in Temple, Texas.
Who’s That PA?
“From our first meeting, she was an exemplar of the diverse ways in which
a PA can support a physician’s practice,”said Robert Probe, MD, chairman
of the Scott & White Clinic Board of Directors.
“In the early years, she brought efficiency to the surgeons doing bypass
surgery as a first assist and endoscopic venous and arterial conduit har-
vester”, said Probe, who is also the past chair of the Scott & White Health-
PA Laurie Benton is the system
director, advanced practice
professionals, for Baylor Scott
& White Health in Texas.
PHOTOCOURTESYOFBSWH

Leading By Example | continued
care orthopaedics department.“In addition, she brought this
skill to others through education locally, nationally, as well as
internationally.”
Andrejs Avots-Avotins, MD, PhD, senior vice president of
medical affairs at BSWH, Central Division, agreed, and added
that,“she was also helpful in ensuring adequate communica-
tion with … physicians and also with the patients themselves.”
“As a teaching institution, I found Laurie’s presence on the
floor to be an added plus in the education of our house staff
and medical students.”
Now, Benton’s impact is felt far beyond the operating room
and patient care units, with regular meetings and decision-
making with the organization’s top executives and officers.
In addition to working as a hospitalist part-time at BSWH,
her work week typically consists of meetings with the chair-
man of the board, the senior vice president of medical affairs,
the hospital board of directors and the medical staff creden-
tialing committee, among others.
Before or after those meetings, Benton reviews and updates practice
and prescriptive authority agreements, bylaws, policy and charters, and
reviews and updates job descriptions. She also communicates with the
healthcare providers on her team, in person, on the phone or via email or
text, and answers questions on PA’s, NP’s and other’s practice. To prepare
for all-of-the-above, she makes sure to keep herself updated on Joint Com-
mission standards, Medicare and Medicaid policies, as well as Texas laws
and legislation.
Blazing a Trail
Benton’s path to the PA profession was not direct. She had never thought
about becoming a PA growing up in Oakland, a small city in Douglas
County, Ore., 55 miles south of Eugene. She does not remember ever hear-
ing about any PAs working there at the time, and in fact, became the first
PA to practice in northern Douglas County.
After more than a decade working as a nurse,“I really wanted to get into
vet school or medical school,”Benton said. Then,“I met my friend’s hus-
band who was a rural PA. He was so compassionate with his patients. They
would bring him homemade soup.”
PHOTOCOURTESYOFBSWH
From left to right is Andrejs Avots-Avotins, MD, immediate past chairman of the Scott & White Clinic Board
of Directors, Robert Probe, MD, current chairman of the clinic board, and Benton.

“[But] the main reason that I was looking for a change was that I was
more interested in the study of medicine. I wanted to learn more. The way
PAs are taught is more about the study of medicine versus nursing.”
While taking undergraduate classes to get ready to study medicine, Ben-
ton also had the opportunity to meet a lot of“great PAs,”and she realized
that the profession’s team concept was exactly what she was looking for.
Plus,“every PA I talked to loved their job,”she said.“When you [meet] 10
or 12 people who love their jobs, you’re just like,‘Wow!’I went to shadow
nurse practitioners, and then shadowed some PAs. They’re both great pro-
fessions. But with my background in emergency medicine, ICU and sur-
gery, the PA program was a better fit at the time.”
In her current position at BSWH, Benton works across the healthcare
continuum and specialties. In the BSWH system, PAs, advanced practice
registered nurses (APRNs) and certified registered nurse
anesthetists (CRNAs) are referred to as advanced practice
professionals (APPs). Benton, as systems director of APPs,
oversees all of them, and reports to the chairman of the clinic
board and the chief medical officer. The chief PA-C, chief CRNA
and chief APRN all report directly to Benton.
“We have an excellent chief CRNA for the system who I partner
with to improve APP practices, and to get rid of the animosity
between professional specialties at the national level,”she said.
“We also work very closely with our chief nursing officer (CNO) to
promote best practices and strong team-based care throughout
the system with the nursing professionals.”
Likewise, physician buy-in and organization-wide support are
big factors in Benton’s success—along with a flexible work
environment. Recently, the administration has recognized the
need to adjust Laurie’s clinical hours to accommodate/facilitate
the duties associated with her executive role.
Also, for Benton, her background as a PA and nurse and her ongoing
clinical work have been big assets to understanding the immediate and
long-term needs of different providers, their specialties and some of the
challenges on the operational side of clinical practice as well.
But, she said, that does not negate the need for more opportunities for
formal PA executive preparation.
“We’re good at clinical care, but we’ve left administrative duties to
someone else to handle. We really need to learn more about the adminis-
trative side of a medical practice,”Benton said.
“There’s a wonderful group of PA leaders who have met in the past five
years to network and share ideas at the [Annual PAs in Clinical Management
Benton oversees nearly 400 PAs and NPs at Baylor Scott & White Health.
PHOTOCOURTESYOFBSWH

and Administration Conference]. There’s also the PAAMS [PAs who are
administrators, managers and supervisors] email site that has been excel-
lent to share information and request advice, but we continue to need
even more information.”
“I was able to attend the Scott & White executive education program
(SWEEP) and the Lean training programs offered to our administrative staff,
which made me realize there is a lot of information that we can share with
and learn from the nonclinical leaders. Good communication and under-
standing of each other’s roles improves both leadership skills and practice
environments for APPs.”
What the future holds
As Benton sees it, PAs have some more work to do to take their rightful
places at the executive level and make an impact behind the scenes of
healthcare.
“We need to know more about regulations, policies, bylaws of not only
facilities, but systems—local and national rules and regulations; healthcare
budgeting; quality initiatives,”she said. “We need to be more familiar with
the healthcare market; sit in on committee meetings to get more of an
understanding. We need to pay more attention to the administrative and
business side of medicine, while using our clinical knowledge to help bring
them together.”
From all accounts, Benton has been going above and beyond to accom-
plish that.
“On the practice side, Laurie continues to be an immensely valuable
asset in assisting with the care of our hospitalized patients,”said Probe.
“With her focus on hospital medicine, she has become extremely skilled
at the management of fluid status, electrolyte balance, cardiac support and
post-operative pain
control.
“I have also been
pleased to work with
Laurie in administration.
Following a competitive
interview process of
internal and external
candidates, she was
chosen as the inaugural
leader of Scott & White’s
Advanced Practice Pro-
fessional Council. This
group has done much to
highlight the value of
PAs and APPs within our
system, to recruit young
talent and to improve the work environment for this group of providers.”
And you don’t have to look far to see the results of Laurie’s and the rest
of the BSWH team’s hard work.
The number of PAs and APPs working for the healthcare system has
tripled over the last decade.
What’s more, Avots-Avotins is confident that the number of PAs and
APPs working alongside physicians in the healthcare system will continue
to grow.
Calling PAs in Healthcare
Administration!
You’re invited to attend Healthcare Administration and
Executive Leadership: A Conference for PAs. Co-sponsored
by the AAPA Center for Healthcare Leadership and
Management (CHLM) and the Wake Forest School of
Medicine, the event is from Nov. 5–7, 2015, at the Wake
Forest School of Medicine in Winston-Salem, N.C.
This two-day conference for PA administrators will provide
leadership training, and improve management and
healthcare administration skills. Attendees will also come
away with in-depth knowledge of the changing healthcare
industry. The event is eligible for 15 hours Category 1 CME.
For more information, contact the CHLM.

$350 PA Students
$425Physician Assistants
This program has been reviewed and is pre-approved for a maximum of 32 hours of
AAPA Category 1 CME credit by the PA Review Panel, 26 hours for three conference
days & up to 6 hours for optional workshops. Physician Assistants should claim only
those hours actually spent participating in the CME activity. This program was
planned in accordance with AAPA’s CME standards for live programs and for
commercial support of live programs.
www.CertMedEd.com
100%Guarantee
or your money back!
Chicago’s Original 100% Guaranteed
3-DAY CME & PANCE/PANRE Board Review
2015 3-Day Conferences
April 25 - 27 Orlando, FL
May 15 - 17 Des Moines, IA
May 15 - 17 Chicago, IL
May 18 - 20 State College, PA
June 5 - 7 Seattle, WA
June 8 - 10 Washington, DC
June 27 - 29 Salt Lake City, UT
August 28 - 30 Syracuse, NY
Sept 18 - 22 Chicago, IL (5 - day)
Sept - 18 - 20 Atlanta, GA
Sept 19 - 21 Denver, CO
Oct 12 - 14 Nashville, TN
Nov 21 - 23 Cleveland, OH
Dec 11 - 13 Las Vegas, NV
Conference Benefits
► 100% Money Back Guarantee
► ~ 99% Pass Rate
► Over 1,000 Practice Questions
► Up to 32 hours of Category 1 CME
$50 Discount
See
W
ebsite
Testimonials
“This course is by far the best, most detailed, and
most useful that I have yet attended. ”
- Lina Quan-Aston, PA-C - Family Practice
Very enjoyable 3-day class. It was affordable as
well as extremely informative! The material
covered was well organized and easy to learn!
Absolutely recommend to people recertifying or
first time PANCE takers."
- Nicole Polke, PA, Cheshire, CT
For more information and to REGISTER go to:
“By PAs, For PAs”
Program Director Michael Nowak, MPAS, PA-C, FAPACVS is
a PA Educator and clinician at the Mayo Clinic. His passion
for education has made Certified Medical Educators the
“GOLD STANDARD” in CME & PANCE/PANRE Board Review.
Certified Medical Educators
NEW PHARMACOLOGY CONFERENCES
Denver, Colorado Chicago, Illinois
See website for details
$295$295
“PAs working at the top of their licenses will be an integral component
of healthcare delivery systems in the future,”he predicted. “If we are to
accomplish the triple aim of healthcare of improving the patient experi-
ence, reducing costs per unit of service delivered and keeping our commu-
nities healthy and well, we will not be able to do so if we can’t readily
increase the number of appropriately trained providers that can help
deliver the quality care that will be required.”
He added,“PAs and APPs will be a major avenue of increasing the number
of qualified providers that will be necessary to accomplish the triple aim.”
For her part, Benton will continue balancing her clinical and executive
responsibilities, making a special effort to stay in touch with medical prac-
tice by keeping her foot in the clinic door and doing her part to increase PA
visibility inside the boardroom, while facilitating PA practice outside of it.
“As the PA profession continues to grow, the opportunities for leader-
ship and administrative positions will become more available for PAs,”
Benton said.“I continue to encourage my peers to engage in leadership
at all levels—from student academies to national organizations.”
CHERISE CARRERA is AAPA’s digital
content manager and a writer/copy
editor for PA Professional. Contact her
via email or 571-319-4432.

What else
could be
going on?
Using the Isabel Diagnosis
Decision Support tool assists
in answering this question.
Isabel helps broaden your differential and provides access to evidence-based reference
material to get to the right diagnosis and treatment sooner. Whether on a desktop or
your mobile device- Isabel is available where and when you want it.
To learn more about Isabel click here: www.isabelhealthcare.com
Isabel is offered to AAPA members at a discount! To receive the discount visit the
member’s only section and click the Isabel link
Why choose CME Resources’ PANCE/PANRE
Review Courses?
H 100% Guaranteed to Pass or Money Back**
H 98% Pass Rate
H Most frequently recommended course by Physician Assistants
H On-site practice exams with results broken out by sub-specialty
H The first PANCE/PANRE Review Course to offer Interactive Technology
** - See website for details
The Recognized Leader
in PANCE/PANRE Courses
The Original Chicago Course
Since 1996
CMERESOURCES.COM
• Our CME 5-day program offers
43 hours AAPA Cat 1 CME credits
• CMExpress is a concentrated
3-day - 26 hours Cat1CME credits
For more information or to register go to
www.cmeresources.com or call 800-522-3439.
2015 Dates & Locations
5-Day Course
Chicago January 7-11
June 1-5
August 3-7
August 19-23
December 7-11
Scottsdale January 19-23
Baltimore February 4-8
Denver February 18-22
San Francisco March 2-6
Orlando March 16-20
Dallas April 15-19
Hilton Head April 29-May 3
Milwaukee May 11-15
Atlantic City June 15-19
Los Angeles July 15-19
Houston August 16-20
Philadelphia Aug. 29-Sept. 2
Las Vegas September 15-19
Boston Sept. 30-Oct. 4
Atlanta October 24-28
Washington, D.C. November 11-15
3-Day CMExpress
Chicago January 9-11
March 20-22
May 1-3
July 31-Aug. 2
December 5-7
Atlanta Jan. 30-Feb. 1
San Antonio Jan. 30-Feb. 1
Denver February 20-22
Washington DC March 6-8
Seattle April 10-12
Pittsburgh May 15-17
Minneapolis May 30-June 1
Orlando June 12-14
Charlotte July 10-12
Las Vegas September 17-19
Boston October 2-4
Cleveland November 6-8
Las Vegas December TBD

2015 AAPA Award Winners Announced
Honoring PA Achievement
T
he AAPA Awards Committee announced the winners of the 2015 AAPA Awards in March. The awards—the highest recognition given to Academy
members—are given to PAs who have distinguished themselves in service to patients, the community and the PA profession.
Join us in congratulating the winners!
Eugene A. Stead Award
of Achievement
Randy D. Danielsen, PhD, PA-C, DFAAPA
Chandler, Ariz.
Named for the founder of the PA profession, the
Stead Award is the highest award given by the
Academy. This award honors lifetime achieve-
ment that has had a broad and significant impact on the PA profession,
healthcare and patients. Danielsen is being recognized for distinguishing
himself as a pioneering national and state PA leader, clinician, educator,
author and editor of scholarly journals. From helping to draft early
enabling legislation in Utah and Arizona, to his service on the AAPA Board
of Directors and as chairman of the NCCPA Board of Directors, to being in
continuous practice as a PA, and accomplished careers as a PA educator
and editor, he has continued to advance the profession and change it for
the betterment of PAs and the patients they serve.
Humanitarian PA
of the Year
Gina R. Brown, PA-C
Wichita, Kan.
This award honors PAs who demonstrate
exemplary service to the PA profession
and the community, and further the PA
profession’s philosophy of providing accessible, quality health-
care—either domestically or internationally—to the underserved
in a rural community or inner city. Brown is being recognized for
her dedication to serving the medically underserved in the United
States and in Afghanistan and Pakistan.
PHOTOSCOURTESYOFRANDYDANIELSEN,GINABROWN

PA_Pro_May_2015

Recommended

Recommended

More Related Content

Viewers also liked

Viewers also liked (17)

Similar to PA_Pro_May_2015

Similar to PA_Pro_May_2015 (20)

PA_Pro_May_2015